sonography

The aim of this study was to determine whether mammographic and sonographic features of malignant breast lesions are correlated with tumor  istologic grade, hormonal receptor, human epidermal growth factor receptor 2 (HER2), and Ki?67 status.

In this retrospective study, imaging and histopathological findings of 187 biopsy?proven breast cancer cases from November 2019 to  February 2021 were reviewed. The Chi?square test was used to examine the potential correlation between mammographic and sonographic characteristics with histopathological features such as hormonal receptor, HER2 status, Ki?67 labeling index, and histological grade.

We observed that microlobulated margin as well as oval/round morphology in mammograms correlate with triple?negative intrinsic subtype (P = 0.006 and P = 0.004). The presence of calcification in sonography was significantly higher in the luminal?B subtype (P = 0.002).  urthermore, ill?defined margins in mammography were significantlyhigher in amplified HER2 expression (P = 0.004) in the same manner as an oval/round shape in higher levels of Ki?67 (P = 0.030).

Mammography and sonography features may reflect the biological behavior of various subtypes of breast cancer and can detect more aggressive breast cancers that can mimic benign or less malignant appearing lesions. These findings may be an excellent predictor for some subtypes like triple?negative breast cancer. Studying the range of these imaging characteristics may help in betterunderstanding the prognosis, choosing a treatment strategy, and predicting response to treatment.

Imaging techniques have significantly impacted physicians ’ capability for diagnosis and differential diagnosis for decades. The aim of this review is to update our knowledge regarding the use of US in orthopedic pediatric patients for diagnostic purposes or procedural/therapeutic purposes. This review demonstrates the application of US in trauma (long bone fractures, radial neck fractures, etc.), developmental anomalies such as developmental dysplasia of the hip and congenital dislocation of the patella, soft tissue pathologies (ganglion cyst, popliteal cyst, hemangioma, lipoma, etc.), tumors, apophysitis, joint effusion, and femoral acetabular impingement. US aid in musculoskeletal procedures has also been reported; US-guided procedures such as aspiration, injection, biopsy, foreign body removal, and peripheral nerve block reduce complications, thus making the procedures safer for the patient. Sonography is a fast, low-cost, mobile, non-invasive, and radiation-free diagnostic tool. Even though US requires a skilled operator and has a long learning curve, in experienced hands is the “orthopedic surgeon’s stethoscope”. Level of evidence: IV

Peripherally inserted central catheters (PICCs) have long been used to provide intravenous therapy to premature neonates. The advantages of PICCs for neonates include avoidance of the pain and handling associated with repeated peripheral intravenous cannulation as well as the ability to safely deliver concentrated parenteral fluid or nutrients. Malpositioned PICC line tips can cause life-threatening complications. There are different intra- or post-procedural techniques to confirm line-tip placement to decrease the potential complications. These include plain radiographs, fluoroscopy, ultrasonographic detection, digital imaging, computed radiography, and intra-cavitary/ trans-esophageal/ and thoracic electrocardiographic monitoring. Each method has advantages and disadvantages and some methods have benefits in specific situations. The present study provides a literature review of common methods developed for detection of PICC tip positions over the last two decades.

Diagnosis of the cystic lesion of the neck in pediatric cases is challenging for radiologists. There are different cystic lesions in the neck region that can present themselves in various parts of this area. Some lesions may lie in the middle parts and some in the lateral areas; however, some cystic defects can be present in every part of the neck. Sonography is the first modality for the assessment of the cases, along with history and physical examination. Sonography is nearly accessible and is not expensive; however, it depends on the expertise of the sonographer. We reviewed sonography findings of various cystic lesions in the neck region and reported the findings with this regard.

The consequences of coronavirus disease (COVID-19) pandemic, especially the financial burden imposed on the healthcare systems and hospitals, have been unpredictable around the world. Radiology wards have been exposed to the highest burden during this pandemic.

This study aimed to calculate the cost of diagnostic imaging services before and during the COVID-19 pandemic, using the activity-based costing (ABC) method in an important diagnostic center of COVID-19 in Khorramabad, Iran.

In this retrospective study, data were extracted from the hospital accounting sources in the radiology ward over two years (2019 - 2021). According to the ABC method, four types of cost were defined, including wage, supporting services, Consuming materials, and overhead expenses. Therefore, based on the monthly number of services, the unit cost of each service was calculated.

The unit cost of all services during the COVID-19 pandemic was higher than before, except for CT scan (before: 6.1 USD; during: 5.6 USD) (P = 0.008). The unit cost of MRI servicewas 5.7 USD before the pandemic and 7.1 USD during the pandemic (P = 0.57); the cost per radiography service was 1.8 USD before the pandemic and 7.1 USD during the pandemic (P = 0.01); and the cost per sonography service was 1.1 USD before the pandemic and 2.8 USD during the pandemic (P = 0.04). Finally, the cost of mammography increased dramatically during the pandemic (before the pandemic: 21.3 USD; during the pandemic: 48.2 USD) (P = 0.004).

The COVID-19 pandemic has increased the radiology department expenses. The cost of CT scan services decreased due to the large number of services provided compared to the pre-pandemic period.

In this study, we aimed to evaluate the accuracy of echocardiography compared to plain radiography in determining the appropriate line tip position of peripherally-inserted central catheters (PICC). Also, we aimed to evaluate the relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and related complications with PICC line tip position.

In this prospective observational study, which was performed in the neonatal intensive care units of teaching hospitals affiliated with Iran University of Medical Sciences in 2019, 50 out of 96 neonates were non-randomly selected based on inclusion criteria. The radiographic and echocardiographic tests were simultaneously performed, and the data were analyzed.

The findings of this study showed that there was an agreement between radiography and echocardiography in determining the PICC line tip position in 43 neonates (86%). The sensitivity and specificity of echocardiography in determining the ectopic position of the catheter were 81% and 77%, respectively. In 32 neonates (64%), a second radiograph prevented the following line manipulation using echocardiography. In addition, there was no significant relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and PICC line complications.

The results of the present study showed that echocardiography was a useful tool for determining the position of the catheter’s tip in LBW neonates. It also minimizes radiation exposure on subsequent radiographs and obviates the need for additional radiographs following catheter manipulation by echocardiography.

Hemothorax is one of the most prevalent complications after thoracic trauma. Extended Focused Assessment with Sonography for Trauma (e-FAST) is one of the diagnostic methods for hemothorax assessment. This study aimed to assess the diagnostic value of e-FAST in detecting hemothorax and its size in patients with blunt thoracic trauma.

This cross-sectional diagnostic assessment was conducted on 400 adult patients with blunt trauma who needed a chest CT scan. Chest X-ray (CXR), sonography, and chest CT scans were performed and hemothorax size was assessed with sonography and CT-scan. Sensitivity, specificity, and positive or negative predictive values of sonography and CXR were calculated. Hemothorax size on sonography was compared with the results of CT-scan as the gold standard.

The mean age of participants was 43.67±22.03. Based on CT scan findings, 176 participants (44%) had a hemothorax. The sensitivity, specificity, positive and negative predictive values, and correct classification rate of sonography were 79%, 99.1%, 98.6%, 85.7%, and 90.2%, respectively. The accuracy of sonography was 97.1% for small hemothorax, 46.9% for medium hemothorax, and 33.3% for large hemothorax.

Sonography is a sensitive diagnostic modality for the detection of hemothorax in multiple trauma patients but tends to underestimate moderate to large-sized hemothorax. Chest sonography can be an acceptable imaging modality if a CT scan is not available or desired.

Mammography (MMG) is the primary screening tool for breast cancer, as microcalcifications are the most common MMG finding in ductal carcinoma in situ (DCIS). The use of high-frequency transducers facilitates the visualization of calcifications on ultrasonography (USG), especially in patients with dense breasts and cancer symptoms. Although a correlation has been reported between the imaging features of DCIS and pathological features, few studies have focused on multiple imaging modalities.

To evaluate the correlation of DCIS microcalcifications in breast imaging with pathological and biological features. Patients and

The MMG and USG findings of 125 lesions detected in 123 patients, diagnosed with pure DCIS, were retrospectively reviewed according to the breast imaging-reporting and data system (BI-RADS). The USG and comparable MMG findings of microcalcifications were divided into three groups: group 1 (MMG negative, USG negative), group 2 (MMG positive, USG negative), and group 3 (MMG positive, USG positive). The pathological findings (nuclear grade and comedo necrosis) and biological features [estrogen (ER) positive group, human epidermal growth factor receptor 2 (HER2) positive group, triple negative group, and Ki-67 index] were compared with the MMG and USG features using Chi-square test.

Microcalcifications were observed on MMG in 83 (66.4%) DCIS lesions. Positive microcalcifications on MMG were significantly associated with a high nuclear grade (P = 0.001) and comedo necrosis (P = 0.001). Positive microcalcifications on MMG were significantly associated with ER negativity (P = 0.023), HER2 positivity (P = 0.002), and increased Ki-67 index (P = 0.001). There were 62 lesions (49.6%) without microcalcifications on USG (group 1 and group 2), while there were 63 (50.4%) lesions with microcalcifications on USG (group 3). Positive microcalcifications on MMG were significantly associated with ER-negative group (P = 0.023), HER2-positive group (P = 0.002), and increased Ki 67 index (P = 0.001).

Based on the present results, DCIS microcalcifications detected via imaging were significantly associated with poor prognostic pathological factors, such as a high nuclear grade and comedo necrosis, as well as poor prognostic biological factors, including ER negativity, HER2 positive group, and a high Ki-67 index.

Pneumothorax is a common finding after trauma and with a wide range of clinical manifestations, from a concealed pneumothorax detectable only by a CT scan accidentally, to a potentially fatal tension pneumothorax. Pneumothorax can gradually progress to tension pneumothorax and become an emergency, consequently, a timely diagnosis is essential. Most traumatic patients have unstable conditions and are risky to transport for radiological evaluation, so they need a fast and bedside way of diagnosis. Currently, sonography is the only acceptable method which is available bedside. This study designed at this center to assess the diagnostic accuracy of ultrasound in trauma condition and comparing to that of CT scan as the final test for pneumothorax diagnosis.

in this cross-sectional prospective and analytical study in 2019, 290 patients were eligible for the study, fitted the Advanced Trauma Life Support (ATLS). A computerized tomography scan (CT) and extended Focused Assessment Sonography of Trauma (eFAST) done for each patient. Sonography performed while regarding the standards for the eFAST examination. During the sonography examination, the process of resuscitation not impaired or stopped. Conform to the entry and exit criteria of the study, data collected in a questionnaire and entered in R software version 3.6.1. A series of tests including Sensitivity, specificity, positive and negative predictive values (PPV, NPV), positive and negative likelihood ratios (LR+, LR-), ROC curve analysis, McNemar test, and the Kappa coefficient used for evaluation. The results compared with that of the CT scan as the definitive diagnostic method.

from 290 patients enrolled in the study,  71% male and %29 were female. The mean age was 38.72 ± 16.7 years, and the age range was 14 to 78 years. The age distribution of the patients was not normal and skewed positively for 20 to 40 years old (median age 34.5 years old). The cause of trauma was non-penetrating in 99.3% and penetrating in 0.7%. According to the CT scan results as the final diagnostic method, 37 patients developed pneumothorax. Ultrasound sensitivity and specificity in pneumothorax diagnosis were 81.1% and 98.4%, respectively. The positive predictive and negative predictive for eFAST were 88.2% and 97.2%. Data fitness evaluated by the Kappa coefficient and McNemar test (Kappa of 0.82 and a p-value of 0.365). These tests showed a high concordance between the two diagnostic methods (eFAST and CT scan) for pneumothorax diagnosis. The area under the ROC curve for sonography was 0.898 and had a relatively good overlap with that of the ROC curve for CT scan.

In general, extended Focused Assessment Sonography of Trauma is valuable in the diagnosis of pneumothorax with a diagnostic value close to CT scan. If positive for pneumothorax, the result is precise, but when negative, additional assessment required due to a lower sensitivity. It could also be a better substitute for a simple chest x-ray.

 Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography.

 We compared the effectiveness of sonography with radiography for confirmation of the line tip placement.

 This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests.

 A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%.

 Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

Myofascial pain syndrome is a chronic syndrome that occurred in a local or focal part of the body. The basis for myofascial pain syndrome is the presence of myofascial trigger point or points, producing pain in clinical examinations.

This study aimed to compare the effect of injection of bicarbonate, hyaluronidase, and lidocaine on myofascial pain syndrome.

The patients were randomly allocated to three groups of bicarbonate, hyaluronidase, and lidocaine. The injection was done at two painful regions of trapezius muscle with a sonography guide for each patient. The values of visual analogue scale (VAS), pre-injection range of motion (ROM), immediately after injection, second and fourth week were measured.

The analysis showed that there were no significant differences between the three groups for age, gender, BMI, and height (P > 0.05). Repeated measures one-way ANOVA (week * group) 4 * 3 was used to compare the effect of bicarbonate, hyaluronidase, and lidocaine on VAS and range of motion (ROM) before injection, immediately after injection, second and fourth week. The results showed that the main effect of group and week is significant for VAS (P < 0.05). This study showed that the values of VAS were significantly different between the three groups during the fourth weeks of the study. Moreover, the patients experienced more pain decline in the hyaluronidase group during weeks before injection, after injection, second and fourth week, which indicated the permanent effect of this medication on pain decline.

Injection of lidocaine leads to a significant reduction in pain immediately after injection; however, the decline was not permanent and disappeared in the following four weeks. But VAS reduction in hyaluronidase group more than bicarbonate and lidocaine groups.

Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis.

In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter.

Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to September 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients.

Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensitivity = 91.9%), 70 patients had posterior shadowing sign (sensitivity = 70.7%), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8%, 100%, 100%, and 32.4%, respectively.

Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing).

 Varicocele is an important cause of infertility in men. Some studies have suggested that because of the similar pathologic processes involved in chronic venous diseases and varicocele, saphenofemoral insufficiency is an example of chronic venous disease, which causes varicose veins in the lower extremity. It is thought that there may be a relation between saphenofemoral abnormality and the emergence of varicocele, but this relation is not backed by sufficient evidence.

 In this prospective diagnostic study, a total of 50 patients suffering from varicocele and 50 control patients were included. Ultrasonography was performed to determine the emergence of saphenofemoral insufficiency (SFI).

 Mean age of patients in the varicocele group and the control group was 32.4 ± 8.44, and 34.9 ± 6.39, respectively. Out of 50 patients being included in the study with varicocele, 8 had left sided SFI and 9 had right sided SFI, while in the control group, 4 patients were diagnosed with SFI, 2 on each side. The difference between the two groups was statistically significant. There was no relation between the time from diagnosis of varicocele, side of varicocele and the existence of saphenofemoral insufficiency.

 Saphenofemoral insufficiency was shown to be significantly related to varicocele, and can be a sign of probability of emergence or re-emergence of varicocele, and further can be used in clinical examination to guide clinicians in diagnosing varicocele.